Highlights & Basics
- Sexual abuse and assault is common and can affect people of any age. Young women and girls are most at risk, but males are also sexually abused and assaulted.
- The diagnosis is complex and has major ramifications; it is therefore important to follow diagnostic guidelines.
- Rapid healing of genital tissues and other factors can result in normal findings on exam following sexual abuse. This is particularly true for children, among whom the majority have normal physical exams.
- Sexually transmitted infections are uncommon in sexually abused prepubertal children.
- The appropriate management strategy is determined by the time elapsed since the sexual assault and the pubertal status of the patient.
Quick Reference
History & Exam
Key Factors
disclosure of inappropriate contact
acute anogenital trauma (any change); transections and absent hymen (in children)
sexually transmitted infections
Other Factors
normal genital findings
emotional and psychological disorders
anogenital lesions
labia and perineum injury
nongenital injuries
vaginal or penile discharge
harmful behaviors
sexual behavior problems in children
chronic medical complaints in children
frequent or persistent genitourinary complaints
hymenal notches
Diagnostics Tests
1st Tests to Order
forensic specimens
testing for Neisseria gonorrhoeae
testing for Chlamydia trachomatis
serologic tests for syphilis
serologic tests for hepatitis B
HIV serology
urine beta human chorionic gonadotropin
testing for trichomonas
anogenital culture: herpes simplex virus polymerase chain reaction (PCR)
LFT
creatinine
BUN
CBC
Other Tests to consider
HIV confirmatory test
HIV RNA PCR
Treponema pallidum hemagglutination assay for syphilis
serum rapid plasma reagin for syphilis
Treatment Options
acute
≤72 hours since assault: preadolescent
safety assessment and counseling
HIV postexposure prophylaxis
hepatitis B vaccine ± hepatitis B immunoglobulin
human papillomavirus vaccine
STI prophylaxis or treatment
Definition
Vignette
Common Vignette 1
Common Vignette 2
Epidemiology
Etiology
Pathophysiology
Images
Absent hymen from 4 to 7 o'clock position in a sexually active 14-year-old girl
Acute vaginal trauma in an 11-year-old victim of abduction and rape
Supine frog-leg position for exam of a prepubertal girl
Knee-chest position for exam of a prepubertal girl
Labial traction technique
Normal annular hymen
Example of the use of a body diagram to record injuries
Sexual assault exam patient handout form
Diagnostic Approach
Associated symptoms and behaviors
- Symptoms of depression and post-traumatic stress disorder: suicidal ideation should also be assessed.[33]
- Chronic medical complaints: may be an indicator for child psychological stress.
- Frequent or persistent genitourinary complaints: may be an indicator of child psychological stress or sexually transmitted infection.
Interviewing
Physical exam when sexual abuse and assault is suspected
- Vaginal discharge
- Anogenital lesions or dermatologic findings
- Hymenal abnormalities or anogenital trauma.Image
Acute presentation: ≤72 hours since abuse or assault
- Evaluation of discharge arrangements to ensure that the child or adult will be returning to a safe environment
- Referral for psychological/social services is also recommended.
- Complete physical exam to assess for possible injuries or other medical conditions. Children who have been sexually abused and assaulted may be at risk of other types of abuse and neglect. It is therefore recommended that a thorough general physical exam should follow the anogenital exam.[33]
- Collection of forensic evidence specimens. Samples such as a mouth swab for the perpetrator's DNA, and urine and blood for toxicology should be collected as soon as possible following sexual assault when indicated. In cases of sexual abuse involving preadolescent children, evidence is more likely to be found on objects present at the assault (e.g. bedding or clothing) than on the child's body.
- Baseline testing for HIV and syphilis.
- Baseline measurement of liver function tests, complete blood count, blood urea nitrogen, and creatinine prior to commencement of HIV postexposure prophylaxis.
- Pregnancy test for females of reproductive age.
- Adolescents and adults may be tested for STIs at the time of presentation. However, detection of an STI may represent an infection acquired before the assault and/or infection in the assailant's secretions. Empiric prophylactic treatment should be considered, as compliance with follow-up visits is traditionally poor.[46]
- Preadolescent children evaluated for acute sexual assault should be tested for STIs based on the history of the assault and clinical manifestations of an infection.[47] Prophylactic treatment is not generally offered to prepubertal children due to the decreased transmission rates of STIs and the evidentiary value of a positive test in a child who cannot legally consent.[30]
- Tests should include the following: Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, hepatitis C, and HIV.[47] If ulcers or vesicles are present, specimens for viral culture should be collected. If a vaginal discharge is present, testing for trichomonas, bacterial vaginosis, Candida, and aerobic culture should be done. Tests for hepatitis C, syphilis, and HIV may not be positive until 3 to 6 months after infection.
- For children and adolescents in countries with universal vaccination for hepatitis B, testing for hepatitis B antibodies is usually not required. In countries without universal vaccination, or if there is no record of hepatitis B vaccination, a test for hepatitis antibodies to determine the need for hepatitis B immunoglobulin or vaccine should not delay the administration of hepatitis B vaccine or immunoglobulin. If required, hepatitis B vaccine may be provided up to 3 weeks after the assault as the hepatitis B virus has a long incubation period.[30] If there is no history or proof of hepatitis B vaccination, hepatitis B immunoglobulin should be administered in addition to vaccination if the assailant is hepatitis B surface antigen positive. Arrangements should be made for subsequent doses of hepatitis B vaccine to be given.
- A forensic exam should be strongly considered for any child, adolescent, or adult, and undertaken as soon as practicable. The recommended timing of the exam depends on the sample type and local jurisdictions; pediatricians should familiarize themselves with their relevant policy. Most protocols recommend that forensic evidence should be collected if less than 72 hours have passed since the assault but some are as late as 168 hours.[33] [37] [48]
- Initial history includes a general medical and social history. All individuals in the room at the time of questioning regarding the sexual assault should be noted. Questions should be carefully documented, nonleading, and open-ended, and responses noted verbatim in the chart.
- A complete but sensitive exam should be performed, including a thorough exam of the skin to note any traumatic findings. Ideally the anogenital exam is performed with a colposcope (or comparable magnification device) that has a photographic capability. All injuries should be carefully documented using agreed nomenclature and body diagrams. The supine frog-leg position is used for the genital exam of prepubertal girls; any abnormal hymenal findings should be confirmed using the prone knee-chest position. Adolescent girls and women are generally examined in the lithotomy position. The use of labial traction greatly enhances visualization of the hymen.Images
- Forensic evidence collection kits are available in most hospital emergency rooms, and include packets in which to send specimens of blood, hair strands and combings, and fingernail, pharyngeal, genital, and anal swabs to a forensic laboratory. In some countries, forensic exam and aftercare are provided in specialist sexual assault centers. The clothing worn at the time of the assault, as well as associated bedding and other samples such as tampons, may also contain forensic evidence.[30]
Nonacute presentation: >72 hours after abuse or assault
- Complete physical exam to assess for possible injuries or other medical conditions.
- A forensic exam, if indicated by regional or national protocols. Recommendations about the timeframe within which collection of forensic evidence specimens (cervical and vaginal samples) from postpubertal females can be performed differ between regions. Most protocols recommend that forensic evidence should be collected if less than 72 hours have passed since the assault, but some are as late as 168 hours.[33] [37] [48] When indicated, a forensic exam should be carried out in the same way as for patients presenting within 72 hours after the abuse or assault.
- Testing for chlamydia and gonorrhea.
- If ulcers or vesicles are present, a specimen for viral culture or DNA for herpes simplex virus should be collected.
- If vaginal discharge is present, testing for trichomonas, bacterial vaginosis, Candida, and aerobic culture should be performed.
- Serologic testing for HIV and syphilis. These tests may not be positive until 3 to 6 months after infection.
- Testing for pregnancy in females of reproductive age.
The clinical significance of physical findings in children
- Periurethral or vestibular bands, intravaginal ridges or columns, hymenal bumps or mounds, hymenal tags, septal remnants, linea vestibularis, hymenal notch or cleft (regardless of depth) above the 3 and 9 o'clock location of the hymen, superficial notch of the hymen at or below the 3 and 9 o'clock location of the hymen, external hymenal ridge, congenital variations in hymenal appearance (crescentic, annular, redundant, septate, cribriform, microperforate, imperforate), diastasis ani, hyperpigmentation of labia minora or perianal tissues, dilation of the urethral opening with labial traction, thickened hymen.
- Erythema, increased vascularity, labial adhesions, vaginal discharge, friability of the posterior fourchette or commissure, excoriations, bleeding or vascular lesions, perineal groove (failure of midline fusion), molluscum contagiosum, anal fissures, venous congestion or venous pooling in the perianal area, flattened anal folds, partial or complete anal dilation.
- Deep notches or clefts in the posterior/inferior rim (between 3 and 9 o'clock) of the hymen in prepubertal girls
- Deep notches or complete clefts in the hymen at 3 or 9 o'clock in adolescent girls
- Complete clefts/transections at 3 or 9 o'clock
- Wart-like lesion in the genital or anal area
- Vesicular lesions or ulcers in the genital or anal area
- Marked, immediate anal dilation.
- Genital or anal condyloma acuminatum: the specificity for sexual transmission is indeterminate if there are no other indicators of abuse. Lesions appearing for the first time in a child older than 5 years of age may be more likely to be the result of sexual transmission.
- Herpes type 1 or 2 in the genital or anal area: may be innocently transmitted, autoinoculated, or sexually transmitted. The presence of the infection is not diagnostic of sexual contact in a child with no other indicators of abuse.
- Acute trauma to external genital or anal tissues, such as acute lacerations or extensive bruising of labia, penis, scrotum, perianal tissues, or perineum and fresh laceration of the posterior fourchette, not involving the hymen.
- Perianal scar, and scar of posterior fourchette or fossa.
- Laceration of the hymen
- Acute ecchymosis, petechiae, or abrasion on the hymen
- Hymenal transection (healed) between 4 and 8 o'clock of the hymenal rim, and missing segment of hymenal tissue
- Perianal laceration with exposure of tissue below the dermis.
- Positive confirmed culture for gonorrhea from genital area, anus, or throat outside the neonatal period.
- Positive culture from genital or anal tissues for chlamydia, if child is older than 3 years at time of diagnosis and specimen was tested using cell culture or comparable method approved in the US by the Centers for Disease Control and Prevention.[46]
- Confirmed Trichomonas vaginalis infection in a child older than 1 year of age.
- Confirmed syphilis if perinatal transmission is ruled out.
- Positive confirmed serology for HIV if perinatal transmission, transmission from blood products, and needle contamination have been ruled out.
- Positive pregnancy test
- Sperm identified in specimens taken directly from a child's body.
Trauma in adults
Online resources
- Canadian Paediatric Society: the medical evaluation of pre-pubertal children with suspected sexual abuse: position statement providing an evidence-based, trauma-informed approach to the medical evaluation of prepubertal children with suspected or confirmed sexual abuse.
Risk Factors
History & Exam
Tests
Differential Diagnosis
Differentiating Signs/Symptoms
- Hour-glass configuration; chronic condition; hypopigmentation.[52]
Differentiating Tests
- Clinical diagnosis by a specialist.
- Symptoms are relieved with corticosteroid treatment.
Differentiating Signs/Symptoms
- Doughnut-shaped urethral mass with hematuria.[53]
Differentiating Tests
- Clinical diagnosis.
Nevus
Differentiating Signs/Symptoms
- Persistent finding of brown or black papule or macule on repeat exam.
Differentiating Tests
- Clinical diagnosis.
Hemangioma
Differentiating Signs/Symptoms
- Persistent finding of red nodule on repeat exam.
Differentiating Tests
- Clinical diagnosis.
Molluscum contagiosum
Differentiating Signs/Symptoms
- Smooth umbilicated lesions.
Differentiating Tests
- Clinical diagnosis.
Nonspecific vaginitis
Differentiating Signs/Symptoms
- History of use of potential irritants (e.g., bubble-bath); poor hygiene. Vaginal irritation may lead to friability and bleeding.
Differentiating Tests
- Clinical diagnosis.
Differentiating Signs/Symptoms
- May present with vaginal discharge, vaginitis, or vaginal bleeding; toddlers and elementary school age children. Toilet paper is most common foreign body.[54]
Differentiating Tests
- Clinical diagnosis.
Criteria
- Periurethral or vestibular bands, intravaginal ridges or columns, hymenal bumps or mounds, hymenal tags, septal remnants, linea vestibularis, hymenal notch or cleft (regardless of depth) above the 3 and 9 o'clock location of the hymen, superficial notch of the hymen at or below the 3 and 9 o'clock location of the hymen, external hymenal ridge, congenital variations in hymenal appearance (crescentic, annular, redundant, septate, cribriform, microperforate, imperforate), diastasis ani, hyperpigmentation of labia minora or perianal tissues, dilation of the urethral opening with labial traction, thickened hymen.
- Erythema, increased vascularity, labial adhesions, vaginal discharge, friability of the posterior fourchette or commissure, excoriations, bleeding or vascular lesions, perineal groove (failure of midline fusion), molluscum contagiosum, anal fissures, venous congestion or venous pooling in the perianal area, flattened anal folds, partial or complete anal dilation.
- Deep notches or clefts in the posterior/inferior rim (between 3 and 9 o'clock) of the hymen in prepubertal girls
- Deep notches or complete clefts in the hymen at 3 or 9 o'clock in adolescent girls
- Complete clefts/transections at 3 or 9 o'clock
- Wartlike lesion in the genital or anal area
- Vesicular lesions or ulcers in the genital or anal area
- Marked, immediate anal dilation.
- Genital or anal condyloma acuminatum: the specificity for sexual transmission is indeterminate if there are no other indicators of abuse. Lesions appearing for the first time in a child older than 5 years of age may be more likely to be the result of sexual transmission.
- Herpes type 1 or 2 in the genital or anal area: may be innocently transmitted, autoinoculated, or sexually transmitted. The presence of the infection is not diagnostic of sexual contact in a child with no other indicators of abuse.
- Acute trauma to external genital or anal tissues, such as acute lacerations or extensive bruising of labia, penis, scrotum, perianal tissues, or perineum and fresh laceration of the posterior fourchette, not involving the hymen.
- Perianal scar, and scar of posterior fourchette or fossa.
- Laceration of the hymen
- Acute ecchymosis, petechiae, or abrasion on the hymen
- Hymenal transection (healed) between 4 and 8 o'clock of the hymenal rim, and missing segment of hymenal tissue
- Perianal laceration with exposure of tissue below the dermis.
- Positive confirmed test for gonorrhea from genital area, anus, or throat outside the neonatal period.
- Positive test from genital or anal tissues for chlamydia, if child is older than 3 years at time of diagnosis and specimen was tested using cell culture or comparable method approved in the US by the Centers for Disease Control and Prevention.[46]
- Confirmed Trichomonas vaginalis infection in a child older than 1 year of age.
- Confirmed syphilis if perinatal transmission is ruled out.
- Positive confirmed serology for HIV if perinatal transmission, transmission from blood products, and needle contamination have been ruled out.
- Positive pregnancy test
- Sperm identified in specimens taken directly from a child's body.
Screening
Treatment Approach
Acute sexual assault: ≤72 hours since sexual assault
- STI prophylaxis for children: as the risk of a child acquiring an STI is generally low, the decision to give antibiotic prophylaxis is dependent on the type of abuse and other circumstances, such as whether violence was involved and the local STI prevalence.[47]
- STI prophylaxis for adults: females should be given an empiric antimicrobial regimen for chlamydia, gonorrhea, and trichomoniasis; males should be given an empiric antimicrobial regimen for chlamydia and gonorrhea.[46]
- Hepatitis B vaccination: should be considered in all patients unvaccinated against hepatitis B virus.[46] [47] Vaccination is most effective if administered within 24 hours of exposure. There is limited evidence to guide the maximum interval for vaccination after exposure, but the vaccine is unlikely to be effective >14 days after sexual exposure.[64] If the assailant is known HBsAg positive, one intramuscular dose of hepatitis B immunoglobulin should be administered, preferably within 24 hours of contact.[64]
- Human papillomavirus vaccination: vaccination should be considered in males and females ages 9 to 26 years who are victims of sexual abuse or assault and have not initiated or completed immunization.[46] Although the vaccine will not protect against progression of infection already acquired or promote clearance of the infection, the vaccine protects against virus types not yet acquired.[65]
- Emergency contraception: females of reproductive age should be offered emergency contraception within 120 hours of sexual assault.[30]
Nonacute sexual assault: >72 hours since sexual assault
Treatment of STIs
Emergency contraception
Treatment Options
≤72 hours since assault: preadolescent
safety assessment and counseling
Comments
- In all cases of sexual abuse or assault, the safety of the child should be ensured via reporting (which may be mandatory) and referral to appropriate agencies (e.g., Child Protective Services or law enforcement). Physical injury should be treated as appropriate. All sexually abused children should be offered psychological counseling.[61]
HIV postexposure prophylaxis
Comments
- HIV postexposure prophylaxis (PEP) should be considered for all patients.
- Consultation with an infectious disease specialist is recommended for children who will be receiving PEP.
- See Post-exposure HIV prophylaxis (Management approach) .
hepatitis B vaccine ± hepatitis B immunoglobulin
Comments
- Vaccination is most effective if administered within 24 hours of exposure. There is limited evidence to guide the maximum interval for vaccination after exposure, but the vaccine is unlikely to be effective >14 days after sexual exposure.[64]
- If the assailant is known HBsAg positive, hepatitis B immunoglobulin should be administered.[64]
human papillomavirus vaccine
Comments
- Should be considered in males and females ages 9 to 26 years who are victims of sexual abuse or assault and have not initiated or completed immunization.[46] Consult local immunization schedules for guidance on doses and schedules.
- Although the vaccine will not protect against progression of infection already acquired or promote clearance of the infection, the vaccine protects against virus types not yet acquired.[65]
STI prophylaxis or treatment
Comments
- As the risk of a child acquiring an STI is generally low, the decision to give antibiotic prophylaxis for chlamydia, gonorrhea, or trichomonas is dependent on the type of abuse and other circumstances, such as whether violence was involved and the local STI prevalence.[47] Specimen collection must be obtained prior to treatment.[46]
- STI treatment depends on the causative organism. See Genital tract chlamydia infection (Management approach) , Gonorrhea infection (Management approach) , Vaginitis (Management approach) , Genital warts (Management approach) , Herpes simplex virus infection (Management approach) , and Syphilis infection (Management approach) .
≤72 hours since assault: adolescent or adult
safety assessment and counseling
Comments
- In all cases of sexual abuse or assault, the safety of the adolescent or adult should be ensured via reporting (which may be mandatory) and referral to appropriate agencies (e.g., Child Protective Services or law enforcement). Physical injury should be treated as appropriate. All sexually abused or assaulted adolescents and adults should be offered psychological counseling.[61]
STI prophylaxis (chlamydia, gonorrhea, trichomonas)
Comments
- Females should be given an empiric antimicrobial regimen for chlamydia, gonorrhea, and trichomoniasis; males should be given an empiric antimicrobial regimen for chlamydia and gonorrhea.[46] See Genital tract chlamydia infection , Gonorrhea infection , and Vaginitis .
HIV postexposure prophylaxis
Comments
- HIV postexposure prophylaxis should be considered for all patients. See Post-exposure HIV prophylaxis (Management approach) .
hepatitis B vaccine ± hepatitis B immunoglobulin
Comments
- Vaccination is most effective if administered within 24 hours of exposure. There is limited evidence to guide the maximum interval for vaccination after exposure, but the vaccine is unlikely to be effective >14 days after sexual exposure.[64]
- If the assailant is known HBsAg positive, hepatitis B immunoglobulin should be administered.[64]
human papillomavirus vaccine
Comments
- Should be considered in males and females ages 9 to 26 years who are victims of sexual abuse or assault and have not initiated or completed immunization.[46] Consult local immunization schedules for guidance on doses and schedules.
- Although the vaccine will not protect against progression of infection already acquired or promote clearance of the infection, the vaccine protects against virus types not yet acquired.[65]
emergency contraception
Primary Options
- levonorgestrel
1.5 mg orally as a single dose up to 72 hours after sexual contact
- levonorgestrel
- ulipristal
30 mg orally as a single dose up to 120 hours after sexual contact
- ulipristal
Comments
- Females should be evaluated for pregnancy and offered emergency contraception. Oral emergency contraception should be initiated as soon as possible to maximize efficacy.[66] Levonorgestrel can be taken up to 72 hours after sexual contact, while ulipristal can be taken up to 120 hours after sexual contact.[67] A pregnancy test is not necessary before prescription for oral emergency contraception is provided.[30] [66][68] Oral contraception is unlikely to be effective if taken after ovulation.
- The copper intrauterine device (IUD) is the most effective emergency contraceptive and can be inserted up to 120 hours after the assault. It retains its high efficacy over the full 120-hour window.[66] The IUD should not be considered as an option if the patient is pregnant. See Contraception .
- If menses are delayed by 1 week or more after the expected time, a pregnancy test should be performed.[37]
STI treatment
Comments
- Treatment depends on the causative organism. See Genital tract chlamydia infection (Management approach) , Gonorrhea infection (Management approach) , Vaginitis (Management approach) , Genital warts (Management approach) , Herpes simplex virus infection (Management approach) , and Syphilis infection (Management approach) .
>72 hours since assault: preadolescent
safety assessment and counseling
Comments
- In all cases of sexual abuse or assault, the safety of the child should be ensured via reporting (which may be mandatory) and referral to appropriate agencies (e.g., Child Protective Services or law enforcement). Physical injury should be treated as appropriate. All sexually abused children should be offered psychological counseling.[61]
hepatitis B vaccine ± hepatitis B immunoglobulin
Comments
human papillomavirus vaccine
Comments
- Should be considered in males and females ages 9 to 26 years who are victims of sexual abuse or assault and have not initiated or completed immunization.[46] Consult local immunization schedules for guidance on doses and schedules.
- Although the vaccine will not protect against progression of infection already acquired or promote clearance of the infection, the vaccine protects against virus types not yet acquired.[65]
STI treatment
Comments
- Treatment depends on the causative organism. See Genital tract chlamydia infection (Management approach) , Gonorrhea infection (Management approach) , Vaginitis (Management approach) , Genital warts (Management approach) , Herpes simplex virus infection (Management approach) , Syphilis infection (Management approach) , and HIV infection (Management approach) .
>72 hours since assault: adolescent or adult
safety assessment and counseling
Comments
- In all cases of sexual abuse or assault, the safety of the adolescent or adult should be ensured via reporting (which may be mandatory) and referral to appropriate agencies (e.g., Child Protective Services or law enforcement). Physical injury should be treated as appropriate. All sexually abused adolescents and sexually assaulted adults should be offered psychological counseling.[61]
hepatitis B vaccine ± hepatitis B immunoglobulin
Comments
human papillomavirus vaccine
Comments
- Should be considered in males and females ages 9 to 26 years who are victims of sexual abuse or assault and have not initiated or completed immunization.[46] Consult local immunization schedules for guidance on doses and schedules.
- Although the vaccine will not protect against progression of infection already acquired or promote clearance of the infection, the vaccine protects against virus types not yet acquired.[65]
emergency contraception
Primary Options
- ulipristal
30 mg orally as a single dose up to 120 hours after sexual contact
- ulipristal
- levonorgestrel
1.5 mg orally as a single dose up to 72 hours after sexual contact
- levonorgestrel
Comments
- Females of reproductive age should be evaluated for pregnancy and offered emergency contraception if presenting within 120 hours of the sexual assault. Oral emergency contraception should be initiated as soon as possible to maximize efficacy.[66] Levonorgestrel can be taken up to 72 hours after sexual contact, while ulipristal can be taken up to 120 hours after sexual contact.[67] A pregnancy test is not necessary before prescription for oral emergency contraception is provided.[30] [66][68] Oral contraception is unlikely to be effective if taken after ovulation.
- The copper intrauterine device (IUD) is the most effective emergency contraceptive and can be inserted up to 120 hours after the assault. It retains its high efficacy over the full 120-hour window.[66] The IUD should not be considered as an option if the patient is pregnant. See Contraception .
- If menses are delayed by 1 week or more after the expected time, a pregnancy test should be performed.[37]
STI treatment
Comments
- Treatment depends on the causative organism. See Genital tract chlamydia infection (Management approach) , Gonorrhea infection (Management approach) , Vaginitis (Management approach) , Genital warts (Management approach) , Herpes simplex virus infection (Management approach) , Syphilis infection (Management approach) , and HIV infection (Management approach) .
Prevention
Primary Prevention
Follow-Up Overview
Prognosis
Monitoring
Complications
Citations
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Key Articles
Other Online Resources
Referenced Articles
Guidelines
Diagnostic
Summary
Includes up-to-date recommendations from the CDC on the identification of STIs among sexual assault survivors.Published by
Centers for Disease Control and Prevention
Published
2021
Summary
Guidance for clinicians, including model screening protocols and questions, and guidance regarding acute evaluation of survivors and evidence-gathering kits.Published by
American College of Obstetricians and Gynecologists
Published
2019
Summary
Current recommendations regarding when, how, and by whom medical evaluations of children who may have been sexually abused should be conducted, as well as how the medical findings should be interpreted.Published by
North American Society for Pediatric and Adolescent Gynecology
Published
2016
Summary
Covers medical assessment, the role of the physician, and liaison with parents and with other professionals for treatment and follow-up.Published by
American Academy of Pediatrics
Published
2013
Summary
Recommendations for the obstetrician-gynecologist on how to recognize and provide support for survivors of childhood sexual abuse.Published by
American College of Obstetricians and Gynecologists
Published
2011 (reaffirmed 2022)
Summary
Provides information on best practices for the management of people who present following sexual violence and intimate partner violence in humanitarian emergencies.Published by
World Health Organization
Published
2020
Treatment
Summary
Includes recommendations from the CDC on treatment of STIs, including sections on treatment of STIs for adult and children sexual assault survivors.Published by
Centers for Disease Control and Prevention
Published
2021
Summary
Recommendations on clinical approaches and required competencies in the field of child sexual abuse.Published by
North American Society for Pediatric and Adolescent Gynecology
Published
2016
Summary
Recommendations for obstetrician-gynecologists on how to screen and provide clinical interventions for women and adolescent girls who have experienced reproductive and sexual coercion.Published by
American College of Obstetricians and Gynecologists
Published
2013 (reaffirmed 2022)
Summary
Recommendations for obstetrician-gynecologists on how to screen and provide assistance for women who are experiencing intimate partner violence.Published by
American College of Obstetricians and Gynecologists
Published
2012 (reaffirmed 2022)
Summary
Provides information on best practices for the management of people who present following sexual violence and intimate partner violence in humanitarian emergencies.Published by
World Health Organization
Published
2020
Summary
Field-testing version of evidence-based guidelines for healthcare professionals.Published by
World Health Organization
Published
2014
Summary
Evidence-based guidelines for healthcare providers on appropriate responses to patients who have suffered intimate partner violence or sexual violence. Focuses on female survivors, but some recommendations may also be relevant to male survivors of sexual assault.Published by
World Health Organization
Published
2013
Summary
A guideline to help anyone who works with children and young people to identify signs of abuse and neglect.Published by
National Institute for Health and Care Excellence (UK)
Published
2017